Protocol for Stopping Isotretinoin in Folliculitis Decalvans with Complete Remission

Optimal Treatment Duration

• The American Academy of Dermatology recommends treatment should continue until reaching a cumulative dose target, similar to the approach used in acne vulgaris (120-150 mg/kg), to reduce relapse rates 1, 2

Dosing Considerations and Monitoring

• The American Academy of Dermatology suggests continue monitoring liver function tests and lipid panels monthly during the extended treatment period 2
• The American Academy of Dermatology recommends assessing for mucocutaneous side effects, which are common but can be managed with emollients or topical steroids 3

Tapering Protocol and Common Pitfalls to Avoid

• The American Academy of Dermatology recommends rather than abrupt discontinuation, consider a gradual tapering of the dose over 1-2 months after the extended treatment period 3
• The American Academy of Dermatology suggests continuing treatment for at least two months after achieving complete remission results in decreased frequency of relapse 3
• The American Academy of Dermatology recommends the goal should be to complete a full course that achieves an adequate cumulative dose to minimize relapse risk 1, 2
• Inadequate cumulative dosing increases the risk of relapse, similar to what is observed in acne vulgaris 1
• Failure to monitor for side effects during extended treatment may lead to unnecessary discontinuation or poor adherence 3